我國社補義肢給付制度之缺失與影響：下肢義肢使用者觀點

Problems and Impacts of Taiwan’s Prosthesis Subsidy Policy: A User-Centered Perspective

義肢對於截肢者而言，是非常重要的生活輔具。隨著身心障礙者權益保障法令的進展，我國輔具政策於2012年產生重大轉變，強調從社會環境與結構理解身心障礙者個別化需求，為個人量身訂製適合的輔具服務。然而，從服務使用者經驗來看，卻與政策立意有許多斷裂、矛盾之處。為了解社會局所提供義肢費用補助制度的問題，以及伴隨這些制度缺失所產生的影響，本研究從下肢義肢使用者觀點出發，以質性研究方法，訪談八位曾申請社會局核發義肢補助費用的服務使用者、一位輔具評估人員以及兩位義肢公司業務員。研究發現我國社補義肢給付制度從提出申請、需求評估、到補助內容與核銷，皆有未盡完善之處，導致原本立意良善且支出龐大的福利服務未能充分發揮效能，且對服務使用者產生以下四種負面影響：（一）工作選擇與活動範圍受限；（二）有損身心健康與外在形象；（三）被迫成為非法福利盜竊者；（四）易淪為不平等權力關係下的受害者。最後，本研究針對以上問題，提出具體改進建議，以求輔具福利服務更貼近身障者需求。

Prosthetic devices are pivotal in improving quality of life for individuals with amputations. Over the years, Taiwan has progressively developed policies surrounding persons with disabilities, including a notable change to assistive devices policy in 2012. This change, centered around a social model of disability, was made to prioritize the individual needs of those with disabilities and offer specialized assistive device services. However, despite good intentions and significant funding, this welfare policy is perceived by service users as problematic and at odds with its purported goals. Therefore, to better understand Taiwan’s prosthetic subsidy program, impacts, and defects, this study used qualitative research methods to examine the perspectives of lower limb prosthetic users through indepth interviews with eight prosthetic subsidy service users, one prostheses assessor, and two prostheses sales representatives. Findings from these interviews indicate systemic deficiencies throughout the subsidy application process, the needs assessment, the determining of subsidy scope, and reimbursement procedures. Such deficiencies were shown to negatively impact service users in four significant ways: 1. by imposing limitations at work and in daily activities; 2. by causing physical, mental, and cosmetic harm; 3. by pressuring users into committing welfare fraud; 4. by subjecting users to unequal power dynamics. Finally, this study offers user-centered policy recommendations to address the aforementioned issues and create services that effectively cater to the needs of people with disabilities.